​Here Diego Polo Reg Osteopath and concussion expert explains how our team at City Osteopaths Concussion recovery, treat the different aspect of a concussion so you can recover your  quality of life. 

​Here Reg Osteopath and concussion expert Diego Polo explains the hazards of having a second head injury before your brain has fully recovered from a concussion. He explains about PCS or Post concussion syndrome and why this can occur. He can assess you to help prevent PCS occuring. In the next video he explains how we treat PCS or post concussion syndrome at City Osteopaths. 

​Here Diego Polo Reg Osteopath explains about the reasons for the symptoms of concussion and how it is diagnosed. 

Post Concussion Symptom Severity Scale (PCSS)
This is the Post Concussion Symptom Severity Scale. If you have had an injury compatible with concussion (car accident, neck whiplash, fall, trauma to head and face, sports trauma, etc) and present with at least one of the 22 symptoms after the accident, you need to consider that you may have had a concussion. 
You should grade your symptoms from 0 to 6, where 0 is ‘no symptom’, 1 and 2 ‘low intensity symptom’, 3 and 4 ‘moderate intensity symptom’, and 5 and 6 ‘severe intensity symptom’. ​

Measure your Recovery
On a scale of 0 to 6, with 6 the highest. Please answer the following questions:

• Do you view yourself as being energised and healthy?                                 ......
• Are your performance skills in work as good as they can be?                       ......
• Are you as motivated to do things for yourself as you could be?                  ......
• Do you have a positive attitude towards the company you work for?           ......
• What is your perception of how well you keep up with your workload?        ......
• Is it easy for you to find the energy to do the things that you must do?       ......
• Are your skills with your family as good as they could be?                            ......
• Do you get balance in your life?                                                                    ......

Is it easy for you to get quality time for;

• Family                                                                                                           ......
• Exercise                                                                                                        ......
• Recovery                                                                                                      ......
• Good quality nutrition                                                                                  ......
• Is it easy for you to eat healthfully every 2 to 2.5 hrs throughout the day? ......
• I view myself as joyful                                                                                 ......
• My work has meaning                                                                                  ......
• I feel fulfilled with my personal life                                                              ......
• My life is taken up with burdens / responsibilities (0 for always, 6 for never)    ......
• I experience depression (0 for deep 6 for never)                                          ......
• I have time to relax when tension builds up                                                  ......
• I wish I were another person  (0 for yes, 76for No)                                       ......
• I don’t like my job (0 =’s hate it, 6 =’s love it)                                               ......

​

​Total  ……        (Maximum Total  140)            Functional  %  ......

Choose the appropriate response

How many glasses of water do you drink per day (coffee and soft drinks don’t count) 
A. 0           B.  1 to 2        C.  3 to 6     D.  7 or more                                     …… 
How many hours do you exercise weekly 
A. 0          B.  1 to 2         C.  2 to 3      D. More than 4                                 …… 
How many sick days have you had in the last twelve months 
 A. 5 or more    B.  3 to 4 days    C.  1 to 2 days    D. 0                                …… 
How many minutes do you spend stretching each day 
 A. 0     B.  5 or less    C. 15 or less   D.  more than 15                                  …… 
How many servings of fruit /  vegetables do you have each day 
 A.  0 to 2      B.  3 to 6       C.  7 to 10          D.  11 or more                         …… 
 How often do you take food supplements per week? 
 A . Never       B. Occasionally     C. Less than 3 days per week    D. Daily   ...... 
 What is the average number of hours of sleep you get per night 
 A.  less than 5    B.  5 to 6     C.  6 to 7     D.  7 to 9                                   …… 
 How often do you estimate you laugh in work in one day 
 A.  Never     B.  Seldom     C.  Occasionally    D.  Frequently                      …… 
 How many cups of coffee, tea or caffeinated drinks do you drink per day 
 A. More than 3     B. 2 to 3 cups     C.  1 to 2 cups    D.  0                         …… 
 What is the extent to which you feel challenged and excited by your work 
 A.  Non existent     B.  A little    C.  Moderately     D.  Very                        …… 
  
A. = 0 points        B. = 3 points     C. = 5 points       D. = 7 points         

​Score                  …… 
                                                                                                                          

Total score from previous pages        ……
Grand Total         …… 
Maximum Total          357 

Wellness Scoring Key
  
155  -  190
Red Alert, go straight to hospital, don’t pass go – don’t collect $200 
  
191  -  226
Barely surviving . Take immediate action before you end up at in the red 

227  -  262    
Up and down like a roller coaster, life is a struggle 
  
263  -  298    
Surviving but not thriving, you can do a lot better 

299  -  334    
You are getting there, but keep going 

335  -  357   
You are the King of the World!​

​​Diego Polo Reg Osteopath has specialised in Concussion - here he explains more about what occurs in a concussion. 

​If you or someone you know has any back/neck/jaw issues or a concussion, Diego Polo is the go-to practitioner in Wellington, with over twenty years experience as a physio and as an osteopath. He has only five out of five star Google reviews! Have a listen to his first video of five explaining about concussion. 

​​Currently, it is one of the most researched subjects in the scientific world. What we understand about it has been changing in the last few years and the approach for assessment and treatment is constantly being updated. 

One of the most common misunderstandings regarding concussion is its cause.
We used to think until recently, that it was caused by a direct trauma to the head, which caused the brain to ‘bang’ against the skull causing a sort of bruise on it. We know now this is not true. What really happens is a fast stretch in the brain cells secondary to a movement of acceleration and deceleration of the brain tissue, with or without direct head trauma. This means that you can have a concussion, even without hitting your head. This can occur during the movement of a neck whiplash, for instance.

Another common mistake is rest prescription for concussed patients. We now know that rest should be only prescribed in very specific circumstances and for a very limited time. On the other hand, research shows that controlled and specific prescribed exercises by a capacitated health professional are much more beneficial, even in the early stages of concussion.

​If the concussion is well managed, the energy storage will be back to its regular level within the 30 days and the person will be fine. The proper management for acute concussion includes mainly an assessment for fitness to exercise, controlled prescribed exercise and proper advice and strategies aiming at recovery and gradual return to work/school/driving/sports’ practice. It is important to know that concussion does not cause any visible damage to brain tissue and cells. This is why there are no changes in the image exams, like a CT scan. The biggest problem is that usually most of the symptoms resolve in the first 2 weeks after concussion, however, full recovery has not occurred and if a second concussion happens before the proper recovery (and this is extremely common). Then there is a cumulative effect which may result in
irreversible brain damage and cell death, and this is what makes the recovery much more difficult.  While most people recover in a month, research shows that up to 40% develop Persistent Concussion Symptom (PCS), also known as Post-Concussion Syndrome, which can last for months, or even years.

At CityOsteopaths, we use the most up-to-date scientific evidence-based method of concussion assessment and treatment, which reduces this possibility to no more than 15%. Now, many conditions can cause PCS, this includes reduced blood flow, reduced oxygenation, chronic inflammation, vision, vestibular and neck issues, also mental state can play a part. In our methodology of concussion management, we have the best tools and approach to identify if any of these issues are happening and to provide the best strategies to handle them, through proper advice, specific exercises to address the affected systems, and hands-on treatment. Research data confirms that 1.15% of the worlds population suffers from concussion annually. This corresponds to almost 54,000 people in New Zealand per year, with over 6,000 concussions in the Wellington region. And this is not only related to sports’ activities.
​

Our mission at City Osteopaths is to provide the best current evidence based care for post- concussion treatment to help Wellingtonians back to health. So, if you have suffered a concussion or know someone who is suffering from concussion symptoms, come and see us as quickly as possible. We will help you to feel yourself again!
​
I look forward to seeing you at City Osteopaths, let’s work together!

​​At City Osteopaths Healthcare, we have been treating people with headaches and migraine for over 25 years and have helped thousands of Wellingtonians out of pain and on the path back to better health.

​We have had patients with a constant severe headache for two years, have it resolved fully to a pain free status, with one gentle treatment.

There are many ways skilled hands-on treatment can help with many types of headaches and migraines. First we take a medical history, and then perform the appropriate neurological, physical and osteopathic examination. Each assessment and treatment is carefully optimised for your needs. 

We are able to use a wide range of approaches including manipulation of the appropriate joints with Muscle Energy Technique, Functional, Fascial, Counterstrain, Cranial and Biodynamic Osteopathy. You can have a ‘click’ or choose to have more gentle treatment approaches. It is your choice. 

By freeing up tight muscles, easing stiff joints and assisting optimal nerve and blood supply to the head and brain, it helps your body recover. We also provide posture, exercises and home care advice as appropriate. 

If you would like to talk with one of our practitioners, please call 044991439 and one of us will call you back as soon as we are able. For quickest results, book in via our front desk team on 044991439 or go through our website booking online. 
​
In the meantime, you could try the following:

1. Drink a big glass of water - you may not be aware you are dehydrated and dehydration has been shown to contribute to headaches.
2. Have a rest, close your eyes and do some slow deep breathing. See if you can make your out breath longer than your in breath. Relaxation helps contribute to change in your nervous system to normalise the blood supply.  Lie down if possible and have a nap. 
3. Make sure you have eaten something recently. Low blood sugar can contribute to the onset of some headaches including migraines. Too much sugar can contribute to headaches when your blood sugar drops again. It is better to eat nutritious food to help keep your blood sugar balanced. 
4. Try a heat pack or a cold pack on your neck. This can help with reducing muscle spasm.
5. Do a gentle yoga class  or go for a walk. Gentle exercise and a bit of fresh air can be very soothing and help your recovery.

​We look forward to helping you!

​--> Causes
​Road traffic accidents with rear-end or side-impact motor vehicle collisions are the primary cause of whiplash and chronic neck pain.

--> Whiplash-associated disorders
Whiplash-associated disorders include all symptoms related to the injury. These are graded in the table below.

•  ​​The Osteopathic point of view and treatment
  

While conventional medicine only considers the cervical spine after whiplash, at City Osteopaths we also look and treat nearby strutures. Let's take two examples:

As the evidence-based suggests, we can utilise an osteopathic thoracic manipulation technique called a “DOG”. We apply a specific force in the direction of the first four thoracic vertebrae restriction, until the anatomical barrier is reached and an onomatopoeic sound called “pop” or “crack” is audible, which indicates cavitation of the treated joint. This technique is able to restore the flexion movement of the upper thoracic spine, and consequently to decrease the pain and improve the breathing and functionality of the entire body structures.

Bibliography: 

• Tameem, A., Kapur, S. and Mutagi, H. (2014) ‘Whiplash injury’, Continuing Education in Anaesthesia Critical Care & Pain, 14(4), pp. 167-170. 
• Peñas, C.F., Vega, R.L., Carnero, J.F., Page, J.C.M. (2004) ‘Dorsal Manipulation in Whiplash Injury Treatment: A randomized Controlled Trial’, Journal of Whiplash and Related Disorders, 3(2), pp. 54-7

Extra article to read:
https://www.barralinstitute.com/docs/articles/vm-new-frontier.pdf

​City Osteopaths and City Hyperbaric are well placed to help people of all ages, in conjunction with their concussion healthcare team. Our Reg Osteopaths are able to gently treat any neck, shoulder and back strains that may have occurred and the hyperbaric oxygen therapy reduces brain oedema or swelling and provides the extra oxygen required by injured brain tissue to help the mitochondria to make the energy required to heal damaged or dormant tissue and help restore function.

Ideally, as in this case, we are able to treat the neck injury and concussion as soon as possible after medical assessment after the accident. We like to work in with the concussion care team to help your child make a full recovery. If the concussion occurred many years before it is probably going to take longer to improve or resolve. 

Below is some research for the use of Hyperbaric Oxygen in concussion for children:

“Role of Hyperbaric Oxygen Therapy in Severe Head Injury in Children” 
—Journal of Pediatric Neuroscience. 2012 Jan-April 7(1) 4-8 www.ncbi.nlm.nih.gov/pmc/articles/PMC3401652/

Conclusion: In children with traumatic brain injury, the addition of HBOT significantly improved outcome and quality of life and reduced risk of complications. Patients receiving HBOT were significantly better than the control group with decreased hospital stay, better Glasgow Coma Scale and drastic reduction in disability. 

“Hyperbaric Oxygen Therapy can improve Post Concussion Syndrome years after Mild Traumatic Brain Injury – Randomised Prospective Trial” www.ncbi.nlm.nih.gov/pubmed/24260334
—PLoS One November 2013 10.137/journal.pone 0079995
Conclusion: Convincing results based on a crossover study, demonstrating that HBOT can induce neuroplasticity and significant brain function improvement in mild TBI patients with prolonged Post-Concussion-Syndrome at late chronic stage, years after injury.
The findings here bear the promises that HBOT can be effective in treating other brain impairments like PTSD or repairing radiation damage. It is reasonable to expect that HBOT can help slow down or even reverse metabolic disorders associated with neurodegenerative diseases. 

Please check out our website links below for more information or give us a call on 04 4991439
www.cityosteopaths.co.nz
www.cityhyperbaric.co.nz

​All our Hyperbaric technicians are trained, experienced and skilled. Before coming in for a session you will be sent a HBOT medical questionnaires and information so you will be ready for your Hyperbaric medical with our Director, during which the the process will be fully explained. The most important ability you need for going in the chamber is to be able to equalise your ears as if you were flying or diving. At City Osteopaths and City Hyperbaric we like to work in with your concussion care team to help you make the optimal recovery.

“Role of Hyperbaric Oxygen Therapy in Severe Head Injury in Children” 
—Journal of Pediatric Neuroscience. 2012 Jan-April 7(1) 4-8 
Conclusion: In children with traumatic brain injury, the addition of HBOT significantly improved outcome and quality of life and reduced risk of complications. Patients receiving HBOT were significantly better than the control group with decreased hospital stay, better Glasgow Coma Scale and drastic reduction in disability. 

“Hyperbaric Oxygen Therapy can improve Post Concussion Syndrome years after Mild Traumatic Brain Injury – Randomised Prospective Trial” 
—PLoS One November 2013 10.137/journal.pone 0079995
Conclusion: Convincing results based on a crossover study, demonstrating that HBOT can induce neuroplasticity and significant brain function improvement in mild TBI patients with prolonged Post-Concussion-Syndrome at late chronic stage, years after injury.
​
Please see our information page here www.cityhyperbaric.co.nz for more detailed information including the costs and more research. We do provide a discounted Hyperbaric Oxygen Therapy fee for children with a head injury on a case by case basis.